PROXIMAL HUMERUS FRACTURE


Pathophysiology

Diagnosis

Treatment

  1. Most proximal fxs can be managed initially in ED w/sling or shoulder immobilizer & early ortho follow-up
  2. Nondisplaced or 2-part fxs: (see anatomy below)

Neer classification:

COMPLICATIONS

  Initial Treatment
Splint type & position If referring, sling and swath (only for a limited time)
Standard sling if there is minimal angulation or displacement
Collar and cuff sling if >20 degrees of angulation is present
Initial follow-up visit 3 to 7 days to assess symptoms and begin ROM
Pt instructions Wrist and finger ROM
  Follow-up Care
Cast or Splint type & position If referring, sling and swath (only for a limited time)
Standard sling if there is minimal angulation or displacement
Collar and cuff sling if >20 degrees of angulation is present
Length of immobilization 2 to 4 weeks
After 2 weeks, remove sling for part of the day
Healing time 6 to 8 weeks
Follow-up visit interval Every 2 weeks until satisfactory function is regained
Repeat radiography interval Consider at 1 to 2 weeks if the patient is unable to initiate ROM exercises
(to rule out a change in fragment position)
At 4 to 6 weeks to assess healing
Pt instruction ROM exercises are crucial to regaining function
Shoulder ROM as soon as tolerated
Elbow ROM whenever the sling is removed
After the sling is discontinued, aggressive ROM and strengthening exercises
Indications for Ortho consult Displaced Neer types (two-, three-, and four-part fractures)
Neurovascular injury or open fracture
Significant distortion of bicipital groove
Fracture dislocation

 

 

The four parts of the humerus according to the Neer classification:
1)
Articular surface of the humeral head;
2
) Greater tubercle;
3
) Lesser tubercle;
4
) Diaphysis or shaft of humerus.

"One-part" is defined as a fracture fragment displaced by <1 cm or <45 degrees; two-, three-, and four-part fractures have more displacement and angulation